1,720,976 research outputs found
Natural sources of antidyslipidaemic agents: is there an evidence-based approach for their prescription?
No full textNumerous randomized clinical trials, systematic reviews and meta-analyses have confirmed the antidyslipidaemic activity of different dietary supplements, nutraceuticals and herbal remedies. International guidelines for cardiovascular disease prevention have begun to consider dietary supplements as an evidence-based approach to improve patients’ plasma lipid levels. They already suggest to increasing or supplementing the dietary intake of soluble fibre (especially psyllium), soy proteins, plant sterols, niacin, and fish oil. Among the nutraceuticals, mevacoline and policosanol are both able to reduce plasma LDL-C by a mean of 20%. A preliminary clinical study of berberine has shown it to be the most powerful antihyperlipidaemic natural compound, reducing plasma LDL-C by 25% and triglycerides by 35%. Among the herbal remedies, several placebo-controlled randomized clinical trials have confirmed the anti-Numerous randomized clinical trials, systematic reviews and meta-analyses have confirmed the antidyslipidaemic activity of different dietary supplements, nutraceuticals and herbal remedies. International guidelines for cardiovascular disease prevention have begun to consider dietary supplements as an evidence-based approach to improve patients’ plasma lipid levels. They already suggest to increasing or supplementing the dietary intake of soluble fibre (especially psyllium), soy proteins, plant sterols, niacin, and fish oil. Among the nutraceuticals, mevacoline and policosanol are both able to reduce plasma LDL-C by a mean of 20%. A preliminary clinical study of berberine has shown it to be the most powerful antihyperlipidaemic natural compound, reducing plasma LDL-C by 25% and triglycerides by 35%. Among the herbal remedies, several placebo-controlled randomized clinical trials have confirmed the antihypercholesterolaemic, and antihypertriglyceridaemic properties of aged garlic powder, artichoke leaf extracts, guggul, and fenugreek. Single small clinical trials have also suggested that Korean ginseng, green tea, onion, yarrow, holy basil and arjun have an antihypercholesterolaemic effect
Rice Bran oil
No full textThe prevention of cardiovascular disease events is related to a complex management of conventional and non conventional risk factors. The first approach to reduce the cardiovascular disease risk is a correct dietary approach. Rice bran and its main components have demonstrated theri property to improve the plasma lipid pattern of rodents, rabbits, non-human primates and humans, reducing total plasma cholesterol and trigyceride concentration and increasing the high density lipoprotein cholesterol level
Impact of physical activity on inflammation: Effects on cardiovascular disease risk and other inflammatory conditions
Full text linkSince the 19th century, many studies have enlightened the role of inflammation in atherosclerosis, changing our perception of "vessel plaque due to oxidized lipoproteins", similar to a "rusted pipe", towards a disease with involvement of many cell types and cytokines with more complex mechanisms. Although "physical activity" and "physical exercise" are two terms with some differences in meaning, compared to sedentary lifestyle, active people have lower cardiovascular risk and lower inflammatory markers. Activities of skeletal muscle reveal "myokines" which have roles in both the immune system and adipose tissue metabolism. In vitro and ex-vivo studies have shown beneficial effects of exercise on inflammationmarkers. Meanwhile in clinical studies, some conflicting results suggested that type of activity, exercise duration, body composition, gender, race and age may modulate anti-inflammatory effects of physical exercise. Medical data on patients with inflammatory diseases have shown beneficialeffects of exercise on disease activity scores, patient well-being and inflammatory markers. Although the most beneficial type of activity and the most relevant patient group for anti-inflammatory benefits are still not clear, studies in elderly and adult people generally support anti-inflammatoryeffects of physical activity and moderate exercise could be advised to patients with cardiovascular risk such as patients with metabolic syndrome
Metformin and its clinical use: new insights for an old drug in clinical practice
Full text linkMetformin is generally recommended as first-line treatment in type 2 diabetes, especially in overweight patients, but in recent years new indications for its use have emerged. Metformin has been found to be safe and efficacious both as monotherapy and in combination with all oral antidiabetic agents and insulins. If metformin use during pregnancy and the lactation period is supported by few data, it could be indicated for women with polycystic ovary syndrome, since it could diminish circulating androgens and insulin resistance, thus ameliorating the ovulation rate. Metformin seems to reduce cancer risk, which appears to be increased in diabetics, and is a promising agent for oncoprevention and chemotherapy combinations. Moreover, metformin could find a place in the treatment of non-alcoholic fatty liver disease. Lactic acidosis could be decreased by avoiding metformin use in patients with hypovolemia, sepsis, renal impairment, hypoxic respiratory diseases and heart failure, in the preoperative period and before intravenous injection of contrast media
Tolerability and safety of commonly used dietary supplements and nutraceuticals with lipid-lowering effects.
No full textCardiovascular diseases are one of the highest causes of death and disability in industrialized countries, whereas a large portion of patients in primary prevention have cardiovascular disease risk factors that remain uncontrolled. Lifestyle interventions, including dietary supplementation with natural compounds possessing known lipid-lowering effects, are strongly supported by the international guidelines for cardiovascular disease prevention. Areas covered: This review provides insights on issues concerning the safety of the most commonly used dietary supplements and nutraceuticals with demonstrated lipid-lowering actions. Soluble fibers, phytosterols, soy proteins, omega 3 polyunsaturated fatty acids, monakolines, policosanols, berberine and garlic extracts are all discussed and a specific focus has been placed on their pharmacological interactions. Expert opinion: A relatively large amount of preclinical, epidemiological and clinical evidence has demonstrated the tolerability and safety of the most commonly used dietary supplements and nutraceuticals with demonstrated lipid-lowering action. However, for most supplements and nutraceuticals, no evidence is currently available from long-term trials on morbidity and mortality. Detailed knowledge of specific health risks and pharmacological interactions for each individual compound is needed for the management of frail patients, such as children, the elderly, patients with liver or renal failure, high-risk patients, and patients consuming numerous drugs
Irbesartan: a review of its use alone and in combination with hydrochlorothiazide.
No full textBlood pressure is one of the most important and frequent risk factors for cardiovascular disease morbidity and mortality; however, it is largely uncontrolled in the population. Inhibition of the renin–angiotensin–aldosterone system provides beneficial effects in the hypertensive population. Association of low-dosed diuretics in drug combinations with renin–angiotensin–aldosterone system-blocking agents allows maximum benefit from potassium depletion and control of the compensatory increase in renin secretion, thus increasing the efficacy and safety of the renin–angiotensin–aldosterone system blockers. Irbesartan is a potent and selective angiotensin II subtype 1 receptor antagonist indicated for use in patients with hypertension, including those with Type 2 diabetes mellitus and nephropathy. Once-daily irbesartan administration provides 24-h control of blood pressure. In patients with mild-to-moderate hypertension, irbesartan was as effective as enalapril, atenolol and amlodipine, and more effective than losartan and valsartan (but not olmesartan), in terms of absolute reduction in blood pressure and response rate. Irbesartan also induced regression of left ventricular hypertrophy. Moreover, irbesartan 300 mg/day exerted a significant renoprotective effect in hypertensive Type 2 diabetics. The relative risk of doubling of serum creatinine was significantly lower with irbesartan than with amlodipine or placebo. It was also found to be effective in nondiabetic nephropaties. Furthermore, irbesartan has peroxisome proliferator-activated receptor agonistic effects in in vitro studies and also demonstrated beneficial effects on inflammatory markers of atherosclerosis and endothelial function. The overall incidence of adverse events is similar to that of placebo. A fixed-dose combination of hydrochlorothiazide and irbesartan show additive antihypertensive effects in a dose-dependent manner up to hydrochlorothiazide 25 mg and irbesartan 300 mg, with high tolerability in diverse patient groups. Effects of combination on end-organ protection must be evaluated by broad-spectrum studies. Ongoing trials with irbesartan and its combination with diuretics may provide necessary data to interpret the value of this association among others
Hypertension and diabetes incidence: attention to the confounding factors.
No full textMultimorbidity, defined as the coexistence of two or more chronic diseases, is a common phenomenon. Numerous efforts to establish a standardized instrument to assess the level of multimorbidity have failed until now, and indices are primarily characterized by their high heterogeneity
Preclinical and clinical evidence of nephro- and cardiovascular protective effects of glycosaminoglycans.
Full text linkDespite advances in pharmacological treatment, diabetic nephropathy is still the leading cause of end-stage renal disease and an important cause of morbidity and mortality in diabetics Glycosaminoglycans are long, unbranched mucopolysaccharides that play an important role in establishing a charge-selective barrier that restricts the passage of negatively charged molecules, such as albumin and other proteins, at the level of the glomerular basal membrane Their loss is associated with loss of selectivity and proteinuria Extensive preclinical evidence and some clinical trials suggest that glycosaminoglycans replacement is associated with improvement of glomerular selectivity and of proteinuria Sulodexide could also have some other effects, potentially useful to reduce the renal damage and the cardiovascular disease associated with proteinuria, such as improvement of haemorheological and blood lipid parameters, an endothelium protective effect and anti-inflammatory action This review will discuss the evidence supporting the potential nephroprotective effects of sulodexide and other glycosaminoglycan
CORONARY ATHEROSCLEROSIS STAGING IN PATIENTS DIAGNOSED BY DIFFERENT DEFINITION OF METABOLIC SYNDROME
No full textBackground and Aims: Metabolic Syndrome (MS) is associated to an
increased rate of CHD in general population. However it is not yet clear
which current definition of MS is more useful to screen patients with a
higher risk to have worse atheromasic coronary lesions. Our aim was to
evaluate if different MS definitions are able to differently detect patients
with more serious coronary lesions.
Methods: We consecutively enrolled 184 patients (M:63.6%, W:36.4%;
Mean age: 57,9±10,4 years) with symptoms usually related to reduced
coronary reserve. We classified the coronary lesions as “minimal” or
“serious” on the basis of the indication of revascularization. The patient
were then classified as MS affected or not on the basis of the WHO, ATP
III, and IDF suggested criteria.
Results: The WHO MS definition included the 64% of serious patients,
The ATP III MS definition the 63%, and the IDF MS definition the 72%.
Parameters significantly associated to the worse coronary lesions were the
Waist-Hip ratio (OR 5.3, 95%CI 1.7-11.6) and the diagnosis of diabetes
(OR 8.1, 95%CI 1.2-15.2). No one of the components of the MS appeared
to be significantly associated to the worse lesions in any of the applied MS
definitions.
Conclusion: the IDF definition of MS appears to include a larger
quantity of patients with worse coronary lesions that the WHO and ATP III
ones. However it is not clear if it is the simple effect of unspecific cut-off
applications to high-risk subjects or if it could have a concrete pathogenetic
basis
Berberine: metabolic and cardiovascular effects in preclinical and clinical trials
Full text linkArrigo FG Cicero1, Sibel Ertek21Internal Medicine, Aging and Kidney Diseases Department, Sant’Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy; 2Ufuk University, Medical Faculty, Dr Ridvan Ege Hospital, Department of Endocrinology and Metabolic Diseases, Ankara, TurkeyAbstract: Berberine is a plant alkaloid with numerous biological activities. A large body of preclinical in vitro and in vivo studies support different pharmacological actions of berberine that could be potentially useful in the management of metabolic diseases associated with high cardiovascular disease risk, such as mixed hyperlipidemia, insulin resistance, metabolic syndrome, and type 2 diabetes. Moreover, it seems that berberine also exerts anti-inflammatory and antiproliferative effects that could play a role in the development of atherosclerosis and its clinical consequences. Recently, the metabolic effects of berberine have been demonstrated in humans, opening new perspectives for the use of this molecule in patient therapy. Larger and longer clinical studies need to be carried out to implement the definition of the therapeutic role of berberine in humans.Keywords: berberine, cardiovascular disease, diabetes, cholestero
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